MEDICARE: MR. LINDSAY ERVIN FERGUSON JR. MS, MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC43373	CA

General Provider Information

NPI Number	:	1922308295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LINDSAY ERVIN FERGUSON JR. MS, MFT

Provider Business Mailing Address
First Line	:	1005 A ST
Second Line	:	SUITE 209
City	:	SAN RAFAEL
State	:	CA
Zip	:	94901-3123
Country	:	US
Telephone Number	:	415-258-4515
Fax Number	:	415-236-1830

Provider Business Practice Location Address
First Line	:	1005 A ST
Second Line	:	SUITE 209
City	:	SAN RAFAEL
State	:	CA
Zip	:	94901-3123
Country	:	US
Telephone Number	:	415-258-4515
Fax Number	:	415-236-1830

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2010
Last Update Date	:	11/02/2010

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